Gestational trophoblastic neoplasm in a patient with end-stage renal failure (ESRF): the challenges and lessons learnt.

Gestational trophoblastic neoplasm (GTN) in end-stage renal failure (ESRF) has not been reported. We reported an unprecedented case of GTN in ESRF from an antecedent partial mole. She had total abdominal hysterectomy and bilateral salpingectomy following the diagnosis as the disease was confined to the uterus. A histopathological examination confirmed an invasive mole. Consequently, she received a total of four cycles of single-agent intravenous actinomycin D as she was at low risk. Despite initial response, her disease metastasised to her right kidney for which radiotherapy was given, followed by a total of 33 doses of weekly paclitaxel. She responded to the chemotherapy and currently remains in remission. The choice of chemotherapy and their side effects due to ESRF remain the main challenges in her management. Total hysterectomy should be considered as the first-line treatment for a hydatidiform mole to prevent GTN. A multidisciplinary approach is important to optimise the efficacy of the treatment with minimal compromise of her safety.

Exploration of Patient-Related Barriers to Effective Cancer Pain Management in a Diverse Multicultural Developing Country.

CONTEXT: Cancer pain prevalence is high despite well-established international guidelines on pain management and improved accessibility to treatment. Inadequate cancer pain management can be attributed to barriers related to patients, health care professionals, and health care system. OBJECTIVES: To identify patient-related barriers to effective cancer pain management in a diverse multicultural developing country. DESIGN: A cross-sectional survey study was carried out using Brief Pain Inventory-Short Form to measure effectiveness of pain management and Barriers Questionnaire II to explore patient-related barriers to effective pain management. SETTING/PARTICIPANTS: Patients on strong opioids treated in a comprehensive cancer unit of a public hospital in Sarawak, Malaysia. RESULTS: Among 133 subjects surveyed, 66% reported no pain or mild pain, 34% moderate pain, and 10% severe pain. Despite good pain control, 71% of patients still reported moderate-to-severe interference with daily activities. Fatalism scored the highest median Barriers Questionnaire II score among the four domains of patient-related barriers followed by harmful effects, physiological effects, and communication factor. CONCLUSION: Cancer pain is generally well controlled with more than half of patients reporting mild pain. However, degree of interference with daily activities is still high despite good cancer pain control. Fatalistic mentality need to be addressed for effective cancer pain management. Further studies on health care professional-related barriers and health system-related barriers are urgently needed to provide a comprehensive approach of holistic pain management.